ADDRESS CHANGE REQUEST

1 VEHICLE 1 GARAGE JURISDICTION (city, county, or town where your vehicle is located) To record additional vehicles, complete the reverse side of this formVEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 2 VEHICLE REGISTRATION MAILING ADDRESS Use this section if you own a vehicle that is not located at your residence ADDRESS and you want DMV to mail the vehicle registration renewal notice to an ADDRESS different from those recorded above or if you want to notify DMV of a vehicle that is garaged somewhere other than where you live.

2 If you need to CHANGE the ADDRESS of more than two vehicles, use the additional space on the back of this form NEW RESIDENCE/HOME ADDRESS Enter the ADDRESS where you actually live. Do not enter a post office box number. Virginia law requires you to provide this ADDRESS to DMV. If you CHANGE either your residence/home ADDRESS or mailing ADDRESS to a non-Virginia ADDRESS , your driver's license and/or photo identification (ID) card may be ADDRESS (no Box)CITYZIP CODECOUNTRY RESIDENCE LOCATION (city or county in which you live) NEW MAILING ADDRESS The ADDRESS shown on your driver's license may be either a post office box, business or residence ADDRESS in Virginia. If you choose to have a mailing ADDRESS that is different from your residence ADDRESS , DMV will send all of your documents to the mailing ADDRESS .

3 If you CHANGE your residence/home ADDRESS or mailing ADDRESS to a non-Virginia ADDRESS , your driver's license and/or photo identification (ID) card may be ADDRESSCITYZIP CODECERTIFICATION I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal TELEPHONE NUMBER DATE (mm/dd/yyyy)SIGNATUREDo you want to apply to register to vote or CHANGE your voter registration ADDRESS ? INFORMATION FOR THE DEPARTMENT OF ELECTIONSADDRESS CHANGE REQUEST ISD 01 (04/14/2016)Purpose: Use this form to report a CHANGE of ADDRESS to the Virginia Department of Motor Vehicles.

4 Instructions: Complete this form and submit it to DMV. The Virginia Department of Motor Vehicles is able to capture and store three different addresses (residence, mailing, and vehicle registration). It is very important to DMV that we capture your correct ADDRESS (es). You may also update your records immediately by changing your ADDRESS online at you a citizen of the United States of America? Completion of this section is requested but not required. (Virginia Code ) YES (INITIAL BOX) NO (INITIAL BOX) YES (INITIAL BOX) NO (INITIAL BOX)CUSTOMER INFORMATIONCUSTOMER NUMBER (as it appears on your driver's license or identification card)CUSTOMER BIRTH DATE (mm/dd/yyyy)FULL LEGAL NAME (last, first, middle, suffix)MOVED CORRECTION (typographical error, new 911 ADDRESS , etc.) REASON FOR ADDRESS CHANGE (check one) ADDRESS FIELD EFFECTIVE DATE (mm/dd/yyyy)ADDITIONAL VEHICLE REGISTRATION MAILING ADDRESS ISD 01 (04/14/2016)VEHICLE 3 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 4 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 5 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)

5 STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 6 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 7 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 8 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 9 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 10 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) VEHICLE 11 GARAGE JURISDICTION (city, county, or town where your vehicle is located) VEHICLE MAKETITLE NUMBERLAST four DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN)

6 STATEMAILING ADDRESSCITYZIP CODECOUNTRY DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy)